EUS-guided gastroenterostomy (EUS-GE) has been reported as a safe and effective treatment strategy for patients with malignant gastric outlet obstruction (GOO). The aim of this study was to report the technical/clinical outcomes and the re-intervention rate of EUS-GE in malignant GOO after the introduction of the technique in one center.

This is a retrospective single-center study including patients who underwent EUS-GE for malignant GOO at our institution. All the procedure were performed by one operator using the Wireless Endoscopic Simplified Technique (WEST) after a period of supervised training. Patients with post-surgical anatomy were excluded. Patient characteristics, technical success, clinical success (post-procedure GOO Score ≥2), adverse events, and re-interventions were analyzed.

From August 2023 to October 2025, 27 patients underwent EUS-GE for malignant GOO. One patient with post-surgical anatomy was excluded; 26 were included in the analysis (15 females, 57.7%; median age 71 years, range 42–95). Most patients had pancreatic cancer (20/26; 76.9%). Overall technical success was 26/26 (100%). One patient experienced intraprocedural stent misdeployment, which was successfully managed with placement of a new stent. Clinical success was achieved in 24/26 patients (92.3%). In patients with clinical failure, endoscopic re-intervention (LAMS balloon dilation and placement of a SEMS through the LAMS, respectively) resulted in clinical success. The adverse event rate was 1/27 (3.7%; fever treated with antibiotics). Median follow-up was 58 days (range 19–311). One patient developed GE dysfunction secondary to food impaction after 249 days, which was successfully treated with endoscopic LAMS cleansing.

EUS-GE shows excellent efficacy and safety in patients with malignant GOO. The endoscopic re-intervention rate is low, with high success both in cases of primary clinical failure and in patients with delayed dysfunction.